title: Comparison of procedural sequence in same-day consecutive bidirectional endoscopy using moderate sedation: a prospective randomized study.
abstract: BACKGROUND
  A sequential bidirectional endoscopy is commonly performed. However, the optimal sequence of procedures for same-day bidirectional endoscopy using moderate sedation has not been established.
  
  
  OBJECTIVE
  The aim of this study was to characterize the optimal sequence of endoscopies for sequential bidirectional endoscopy.
  
  
  METHODS
  This was a single-center, prospective, randomized study. A total of 163 patients aged 18 to 80 years, who were referred for bidirectional endoscopy for any indication, were randomized to start with upper or lower endoscopy. Initially, all patients received intravenously 50 mg of meperidine and 2.5 mg of midazolam. Patient's discomfort and satisfaction, as expressed by the amount of analgesia added to sustain conscious sedation, and the postprocedure satisfaction reported by the patients were set as primary outcomes.
  
  
  RESULTS
  There was no significant difference in the total dose of midazolam added, patient's pain assessment and satisfaction from the anesthesia and the procedure, duration of endoscopies, or the time to cecal intubation between the esophagogastroduodenoscopy first and colonoscopy first groups. The rate of diagnosis of significant pathologies and the rate of procedures performed during the examinations were similar in both the study groups. Evaluation of patient's postprocedural recovery did not reveal significant differences. There was no significant variance between the performing physicians regarding anesthetic dosing, duration of examination, pain scoring, and the related patient's pain postprocedural assessment.
  
  
  CONCLUSIONS
  There were no significant differences in the patient's discomfort and satisfaction, regardless of the procedural sequence.
authors.affiliation: *Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan †Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Carter
authors.forename: Adi
authors.initials: A
authors.lastname: Lahat
authors.forename: Neofytos P
authors.initials: NP
authors.lastname: Papageorgiou
authors.forename: Shulamit
authors.initials: S
authors.lastname: Goldstein
authors.forename: Rami
authors.initials: R
authors.lastname: Eliakim
authors.forename: Eytan
authors.initials: E
authors.lastname: Bardan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007557:Israel; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam